Analysis of recurrences of meningiomas following neurosurgical resection
Kajiwara, K.; Fudaba, H.; Tsuha, M.; Ueda, H.; Mitani, T.; Nishizaki, T.; Aoki, H.
No Shinkei Geka. Neurological Surgery 17(12): 1125-1131
1989
ISSN/ISBN: 0301-2603 PMID: 2615895 Document Number: 338213
A clinical and pathological study of 124 surgically treated patients with intracranial meningiomas was carried out to evaluate factors influencing recurrence. The patients ranged in age from 8 years to 75 years. Thirty-five (28.2%) were males and 89 (71.8%) were females. Recurrences occurred in 18 patients, once in eleven, twice in six, four times in one. The period from first surgery to recurrence ranged from 5 months to 84 months (mean 29.9 months). Age, sex, site of tumor, surgical grading, and histology were selected as analytic factors. Simpson's classification was used as surgical grading. All the patients with recurrences were younger than 60 years old, and particularly in the patients who were younger than 40 years the recurrence rate was high. Mean age of the group with recurrence was 41.8 years, which was significantly younger than that of the group without recurrence (52.0 years). In the group with recurrence, ten were males and eight were females. The recurrence rate was 28.6% in males, and was 9.0% in females. Thus the recurrence rate was significantly higher for males than for females (p = 0.016). It also seemed that the period from first surgery to recurrence was earlier for males than for females. The patients with meningiomas at posterior fossa or sphenoid ridge often had recurrences, and the recurrence rate was 29.4% and 21.7%, respectively. But these recurrence rates were not significantly higher than those at other sites. On the contrary, no recurrences occurred at convexity, intraventricle, and olfactory groove. The tumors at the sphenoid ridge and the posterior fossa had a tendency to recur earlier than those at other sites. The surgical procedure was graded according to Simpson's classification from 1 to 4. Grade 5 was excluded from this study. In this series, 36 procedures (29.0%) were Grade 1, 45 (36.3%) were Grade 2, 15 (12.1%) were Grade 3, 28 (22.6%) were Grade 4. The recurrence rates were 5.4% in Grade 1, 8.9% in Grade 2, 20.0% in Grade 3, and 32.4% in Grade 4. Thus the recurrence rate in Grade 4 was significantly higher than those in Grade 1 or 2. And it seemed that there was a tendency for recurrences to occur earlier in Grade 4 than in the other grades. Histological subtypes of meningiomas were classified into 6 groups, which were meningotheliomatous, transitional, fibroblastic, angioblastic, malignant, and atypical. In malignant meningiomas the recurrence rate was high (66.7%), but in the other so-called benign meningiomas there was no significant difference in the recurrence rates. We concluded that age, sex and the grade of the initial surgery were the factors which had a statistically significant influence on recurrence, and among them the grade of the initial surgery was the most important. Recently cell kinetics studies using anti-BUdR monoclonal antibody, anti-Ki-67 monoclonal antibody, and flowcytometry etc, have been performed for the estimation of the recurrence of meningiomas, and much useful information has been provided. But many problems remain unknown, and we should do further studies concerning these problems.